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171: The Cold Hard Facts About Cold Plunging

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171: The Cold Hard Facts About Cold Plunging

Apr 15, 2024

Could stepping into an ice-cold bath hold the key to better health? Or is a cold plunge just another health trend that distracts us from the Core 4? Dr. John Smith did his research and discussed with Scot and producer Mitch some of the potential potential benefits exposing yourself to cold water regularly may have.

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    Scot: Are there benefits to plunging your body into ice-cold water? And I'm talking about on purpose. I'm not talking about you're ice fishing or something and you plunge in. The number of videos that I've seen on social media leads me to believe that maybe there is, or at least there's a good legend and lore and story around it. Are you guys seeing these videos about cold plunging?

    Mitch: Yeah, a couple of the podcasters that I follow swear by it every single morning.

    Scot: Really? Okay. How about you, Dr. Smith?

    Dr. Smith: Absolutely. My brother actually is a big cold-plunger, and I have quite a few of the folks that I work out with occasionally have actually bought the cold-plunging apparatus, and they have them at their houses.

    Scot: Those things aren't cheap.

    Dr. Smith: Well, some of them are. I mean, you can get the ones that are blow-up for under $100, and then you can go to C-A-L Ranch and buy a tub there for $100 and put a bag of ice in it. But the actual plunge ones, yeah, you're talking several thousand dollars.

    Scot: Where you don't have to constantly put ice in it. It just keeps that water icy cold.

    Dr. Smith: Right. To a point.

    Scot: We're going to talk about cold plunges today. We're going to see if there's any sort of benefits. We're going to talk about what we have heard. And then Dr. John Smith's done some research to find out what research says about cold plunging.

    I really wonder if there's benefit for just kind of us regular guys. I consider myself a regular guy. I exercise just to try to stay fit. I'm not looking to push my performance, any of that sort of stuff. So we'll dive into all of that.

    This is "Who Cares About Men's Health," with information, inspiration, and a different interpretation of men's health. I have embraced the chill once or twice on vacation, but not regularly. My name is Scot. I'm coming with the BS. The MD to my BS, urologist Dr. John Smith.

    Dr. Smith: Howdy.

    Scot: And he's a "Who Cares About Men's Health" convert, Producer Mitch.

    Mitch: I can't even do a cold shower regimen for longer than two days. I am not interested, but I'm excited to hear.

    Scot: Yeah. I mean, when I said I was on vacation, I think I was in Las Vegas at some hotel, and they had a spa, and I treated myself to a spa day. They had a cold plunge there next to the hot tub, and I really enjoyed it, right?

    And I've been up to the hot springs in Idaho here. We're from Utah. And they have the cold baths, and then you get in the hot baths, and I enjoy that a lot. I like how it makes me feel.

    So when I saw all these guys on the internet, I'm thinking, "Wow, this sounds like a great idea. I think I'd like to do this at home." But then, Mitch, I came to the realization that I could just stand under a cold shower for a few minutes, and I refuse to do that. So why am I going to spend time and money to set up a system for cold plunging? But I am still curious.

    So what have you guys heard? Mitch, what have you heard the benefits are? I'm just kind of curious what stories are circulating out there, and then we'll compare that to what we know research says.

    Mitch: So the strangest one for me is that on my ADHD TikTok that I follow, there are people that swear, absolutely swear, that cold plunges can improve nervous system balance, cognitive function, ADHD symptoms, and that seems a little out there for me. Can I take a cold shower and feel better? I don't know if that's actually helping my brain, right?

    But the thing that I'm always kind of nervous about is . . . I was under the impression that if you jump from really hot water to really cold water, it was not good for your heart.

    Scot: All right.

    Mitch: So I don't know.

    Scot: Have you heard other benefits that you could hit on?

    Mitch: You've got things like building resiliency. I've seen a couple of podcasters swear that they haven't gotten a single cold since they've been doing cold plunge. The fact that it helps with soreness and inflammation.

    Scot: Yeah, and improves the immune system. Before you did the research, John, what had you heard? What were the narratives?

    Dr. Smith: A lot of people will say it can decrease your risk of diabetes or improve your insulin resistance. And then you'll see some folks talking about cold shock proteins that can help scavenge for free radicals.

    People will talk about just overall improvement in your GRIT score for some of those folks who know some of those things, which is kind of the resilience, and doing hard things, and having that sense of accomplishment.

    And then overall health and wellbeing of decreased inflammation, things like that. That's probably the one that most people think about, because you see athletes sitting in the cold tubs after they get done competing.

    So those are some of the main things. And then there are those that say it stimulates the immune system as well. And so those would be the biggest things that I see out there for sure.

    Scot: Yeah. I've seen all of those too, and I feel like my processing on this is that this just all kind of fits into this bigger narrative that our lives have gotten too comfortable. And because of this comfort, we live in temperature-regulated homes, we go to work at temperature-regulated buildings, and as a result, our body needs to have these shocks, these heat and cold shocks. And by doing so, it makes our body do things that they're just not doing right now that bring these benefits that we talk about.

    Of course, at this podcast, personally I get concerned about . . . I like shiny objects, right? So sometimes it's easy for us as guys to go, "Oh, cold plunges. That's how I'm going to get healthy," as opposed to focusing on the things that we know time and time again that unfortunately sometimes can take some work, like the Core Four that we talk about, our nutrition, our sleep, our exercise, our emotional health, nagging health issues, the genetic issues.

    But I am definitely open to finding out more about cold plunges, if it would be something for a regular guy like me, or if it's going to be something for people that are looking for more performance or that sort of stuff.

    So without further ado, Dr. Smith, what have you discovered in the research?

    Dr. Smith: So what I've discovered is that there's a lot of literature out there, and the quality of the evidence is not super high in a lot of cases. However, there are plenty of studies that are out there that make claims.

    And so I would put a disclaimer on before you do this, kind of take stock if you're not healthy, make sure that you are healthy enough. Never try to get into something that's colder than it should be or that you're uncomfortable with or that you don't think you're going to be able to deal with.

    But some of the benefits are starting to be elucidated in the literature a little bit better. One of the most common things that I've seen is the activation of brown fat.

    So there are a few types of fat. Brown fat in our bodies has a thermoregulative capability to help us regulate our temperature, and the cold plunging and getting into cold water, even down to 50 degrees, and even less than that or even a little bit warmer than that, you can start to see some of the benefits.

    And so once it's activated, brown fat either uses glucose, which is what our body normally runs on, which is sugar, or it can run on fatty acids to try to help warm the body up. And so a lot of the benefits that are kind of coming forward are that where it can kind of help with metabolic rate and things like that.

    A lot of the studies say that you burn more calories as you're warming up. And so some of the studies say that you should get into the cold water and then get out and let your body warm up.

    Kind of get that shiver when you're cold and allow your body to shiver, because that's, number one, going to create additional heat. Then your metabolism is going to be stimulated and you're going to improve the brown adipose tissue in the body and help it be more active and help you burn more calories.

    So that's one that you see across the board that a lot of people mention.

    Scot: I want to jump in on the brown fat thing. So how much cold plunging do I have to do to notably change my composition of brown fat?

    Dr. Smith: Eleven minutes a week is what a couple of the studies said.

    Scot: Oh, really? They do have a number?

    Dr. Smith: Yeah. So if you follow some of the folks that are out there that do it, a lot of them look at a study that was done back in 2001, and it's a free article. You can go and find it. It's "Altered Brown Fat Thermoregulation and Enhanced Cold-Induced Thermogenesis in Young, Healthy, Winter-Swimming Men." That's the name of the study.

    Scot: Yeah, I don't fit in any of those groups.


    Dr. Smith: And that's one of the biggest knocks on a lot of the literature. They took a bunch of young, healthy men, and so how do you extrapolate that in Scandinavian countries? How do you extrapolate that out to females of any age group, men of older age groups, racial diversity, things like that, where you look at and you want to know, "Well, is this healthy across the population?"

    And I think most people have been in the cold, it's probably not a huge deal, but that's one of the biggest knocks on the literature. They take a lot of these studies and they have a lot of these cohorts of men who are doing the polar plunges and things like that.

    And as that's become more popular, they're now getting a little bit more . . . as far as the cohorts they have and having a more diverse group of folks that you can actually look at and quantify some of that.

    But that study showed that these folks were getting in cold water two to three times per week on an average of 11 minutes per week, and it showed an increase in that brown fat as they did it.

    Now, some of these folks also used a sauna, where they would go from cold to hot, cold to hot, cold to hot, like you were saying, Mitch, where you've heard that was bad. The literature doesn't necessarily show a bunch of that as far as these studies that I was looking at. But again, only a few of them had the hot, cold, hot, cold, so I couldn't really speak deeply into that. But a lot of these folks did it and it didn't seem to hinder their ability, their performance at all.

    Scot: And then as far as brown fat is concerned, this really fits into this narrative of we live a cushy life, right? We live a temperature-regulated life. And it used to be we'd have to have brown tissue in order to survive being out in the cold so much more. Even when we were inside, we were in the cold, right?

    Dr. Smith: Yeah. And I think there is some of that. They saw in this study that there was more activation sooner of these brown fat areas that were there. And so I think that is something.

    But if you look at some of these folks that have these different protocols and things, a lot of them will look and say three to eight minutes a day at the most. And if you look at that, a lot of the studies they're looking at were doing this two to three times per week.

    And again, the literature is not as robust as we would probably like it. However, I think that once people start doing it, they feel better. And so they're like, "Well, I'm going to continue to do this because I feel like there is some benefit here."

    Scot: And I guess from a medical standpoint, if there are not major downsides . . . Like Mitch mentioned, if you've got a bunch of people that are doing this and then having heart attacks, that's the downside, right?

    Dr. Smith: Right. When you get in cold water, cardiovascularly you have an increase in blood pressure because your body constricts all the blood vessels. And so you end up with an increase in your blood pressure, but then it actually decreases your heart rate. In a lot of the studies, it showed a decrease in heart rate. And so some of those things can show as beneficial.

    And then those areas, it shunts more blood to the core of your body to maintain body heat. And so you actually get an increased blood flow to those areas and a decreased blood flow to the periphery. There is some thought that those things are beneficial to kind of push that there.

    And then as you warm up, obviously, the thermoregulation stuff that you talked about. But that vasoconstriction at the extremities and then vasodilation to pull all that and maintain all that heat in the core of your body is talked about in quite a few of those studies.

    Scot: So 11 minutes. And then how long before you start noticing . . . Two months? Three months? Did they mention that in any of the studies?

    Dr. Smith: Not a lot of them talk about the time of like, "Hey, you should see . . ." Not a lot of them were doing it about weight loss. A lot of them were doing it to talk about different things like, "Our end point was did people have less insulin resistance after this study?" or whatever. And there were some studies that showed that it may help with insulin resistance in people who are diabetic and have insulin resistance.

    Scot: All right. So the brown fat factor, that is one thing you found. What else did you find?

    Dr. Smith: So, again, the insulin resistance factor was there. I mean, there are a bunch of studies that talk about even just doing a cold shower. There was one study that did a quick study of people who took a cold shower for 30 days and then asked them if they felt like they got sick less, and they said yes. But they actually had the same amount of sick days as their other cohort people. So it's more of a . . .

    And again, that's where it leads to, "Is this about the perception of how you feel?" If you walk in every day and you have the attitude of, "I'm going to crush today," or you walk in with the attitude of the donkey from Winnie the Pooh, you walk in like Eeyore, what is it to that? And I think there probably is something to the aspect of achievement, the aspect of a lot of those things. I think that there is something to that.

    Scot: Yeah, like the placebo effect.

    Dr. Smith: Exactly. And not even placebo, but I think the mental aspect of, "I've persevered. I've overcome. I can sit in this cold water for three minutes." And you think about how many people around you are doing that, it's probably none. There is that sense of achievement, like, "I'm doing something." You know what I mean?

    Scot: Yeah. And they're far lesser than me because of it.

    Dr. Smith: Yeah. I'm building resilience. I'm more resilient than I was because I have control over my body. And then it may push you to take control over other things in your life. I mean, those are real mental things.

    That's why when you see on TikTok, Mitch, those folks . . . I mean, I think there is a component to that and there are studies that talk about reinforcing yourself and your ability to have control on your body and your brain. And some of them call it top-down control over yourself and building those mechanisms of coping with some of those mental challenges.

    Mitch: Interesting. But it's not necessarily I guess fixing brain chemistry necessarily, but maybe it's helping a person feel and have that kind of . . . what is it? Self-efficacy? This belief that they can?

    Dr. Smith: Yeah. And I think some of that too, when you do have that sense of achievement, I think that there are some studies out there . . . and I will dig a little deeper into this because I didn't dig down this rabbit hole. But I know that there are some studies that show that when you do have achievement like that, you do have a release of dopamine or that reward pathway.

    Mitch: Oh, sure.

    Dr. Smith: And so there really likely is also a dopamine release during that time too, where you're having that as well. You are getting that as well.

    Mitch: So, John, what about . . . I mean, sure, we talked a little bit about maybe potential dopamine release, but we still need to do some research on that, etc. But what about mood, right? That's another one that I see all the time. Being someone who's struggled with anxiety before, who's had bouts of depression and stuff like that, is there any research saying that cold plunging might help with that?

    Dr. Smith: So there is some literature out there that people have felt less anxious and felt less depressed because of the way they feel. There is some evidence that's out there. It's not super strong evidence, so I wouldn't want to just say, "Hey, here you go." But they did have a pilot study of about 50 people, and they kind of gave them these questionnaires of how they felt, and a lot of these folks found that they felt better.

    Then there are other studies, and these are kind of smaller number studies, but these people all said that they had improved or elevated mood even after just one . . .

    Mitch: Oh, interesting.

    Dr. Smith: . . . session in the water. So, again, those are the things where you've got these studies out there where it's not super robust, but then you're having it kind of amplified and multiplied out there on social media of, "Hey, I started doing this, and I stopped taking my anxiety medication," or whatever you're seeing out there.

    And I think that there may be something to it. We just don't know exactly what it is. Maybe it is that dopamine release, and I think that there's a little bit more that we probably need to get to with that. But there are some smaller studies that are showing that folks even with one exposure are noticing a marked improvement.

    Scot: One of the things I hear a lot about is that this can help with inflammation. Isn't that why athletes do it? Because when you put cold on an area, it takes down the inflammation. You're trying to get rid of that inflammation after doing hard athletic things. Can you talk about what you found on that?

    Dr. Smith: Yeah. So a lot of that goes back to that vasoconstriction, where you're having less inflammatory cells get to those muscles and you're decreasing inflammation. And there are some things out there. There are a few books that have been written and a couple of other things that talk about using this for chronic inflammation, fibromyalgia, arthritis, even inflammatory bowel disease, where they talk about it.

    But again, the overarching theme of the day is, yes, there are these small studies and oftentimes it's, "How do we extrapolate that to the public?" And that's the hard part when you look at this. Yeah, you've got these people with study protocols that are advocating for these things, but they're small studies, generally 40, 50 people, even 8 people, 12 people, that are showing a decrease in inflammation or show a release of anti-inflammatory markers during cold exposure when they take some blood work.

    But again, how do you extrapolate a study of 50 people, 40 people to everyone? I think that's the overarching theme. There's a lot here that looks promising. It really does look promising. And if these studies are true, where there is this release of anti-inflammatory markers and things like that that are going to be improved, I think that's why you're seeing such a big trend of people being willing to do it.

    I mean, it's not really going to hurt you. If you're getting in water for two, three minutes, you get out, you warm up, you're not freezing cold, and you go about your day and you feel better, I think these people are willing to try anything who have these chronic conditions.

    Scot: Right. Yeah, that makes sense. I want to address, though, do we know that it won't hurt you? The thing that I was shocked by when I first started working in healthcare was aspirin for high blood pressure as a way to help prevent heart attacks. And I'm just like, "Well, what's the big deal? I mean, there's no harm in taking it."

    Well, when they do research, they actually find that aspirin has some negative side effects to more people actually than it was benefiting in those instances. It's just you don't hear about those things or we don't know about those things.

    Dr. Smith: Sure. I mean, you're right. There are obviously risks associated with anything, but I think if you're doing it safely . . . I mean, if you're going to start this and you said, "Hey, you know what? Let me just try some of this cold and maybe not go super cold," and find an opportunity to maybe turn your shower down to the coldest setting it will go, that's unlikely to cause hypothermia or cause any huge problems that way, if that makes sense.

    Scot: Yeah. And it's not a heart attack response like Mitch . . .

    Mitch: Right.

    Scot: Now I'm really freaked out that we're advocating for this, but yet there could be something lurking that we don't know about.

    Dr. Smith: There are those things where I think if you're worried about it, getting into water that's not super cold, but cold enough that it brings it down to . . .

    I mean, some of these folks on social media are saying that a cold shower is just as effective as getting in a cold plunge at 50 degrees or whatever it is. And I think that's something that you could probably do safely, of turning your shower down colder to where it's going to help you.

    Now, what are the benefits? Are you doing it exactly the way these protocols were done? Unlikely. But if you feel better that day and you feel more awake and alert and you turn that shower cold for 30 seconds and you were like, "Hey, I feel better," again, I don't see the harm in it.

    Now, again, obviously I'm not giving people a bunch of medical advice here to just say, "Hey, go do this." But I think when you do it, if you have worries about it . . . A lot of these studies, they took 25-year-old men that were already swimming in cold water and they were like, "Hey, we want to do a study with you guys and pull some blood and do some MRIs on your body to see what's going on when you jump in cold water," and they're like, "Yeah, that's fine."

    If you're a poorly controlled diabetic that's overweight and in your 60s, you're probably not the person who's doing that. So take it slow and be smart.

    But I think if you are interested, probably the best thing to do would be just to take your shower, turn it down a few degrees, and stay in there, and then do that for a little while and see if you feel like there's help there. I think that's probably a very safe route to go that's not going to cause anybody to have a heart attack.

    Scot: Getting back to the chronic inflammation, there is a YouTube channel that I love called ATHLEAN-X, and the guy on there, his name is Jeff Cavaliere. He was a strength and conditioning coach for the Mets back in the 2000s. He's a physical therapist. He really kind of knows his stuff and he talks a lot about science and research.

    And I thought this was interesting. He was kind of cold on cold plunges. No pun intended, but appreciated nonetheless. And he said that there's some research out there that indicates that you shouldn't do it if you're a strength trainer right after you strength train, because it could actually dampen the inflammatory response that's part of the muscle-building process. So it's not like you want to do it right after you work out.

    So I thought that was super interesting, and I'll see if I can find that. We'll put a link to him talking about that.

    Dr. Smith: Well, there's actually some stuff that says you shouldn't take anti-inflammatories after as well for the same reason.

    Scot: Oh, okay.

    Dr. Smith: So taking ibuprofen, things like that, there is literature out there that says that it blunts the body's ability to kind of build itself back up. All of those factors that are coming in to heal after you've done a workout . . . You've kind of torn your muscles down and they need to be rebuilt, and when you take anti-inflammatories like that, you're shutting down your body's ability to do that. And that's exactly what the cold plunge could do as well. I mean, he's probably not far off on that.

    Scot: I mean, it could be really easy to think, "All right. I got done with my workout. Now I'm going to go do the cold plunge because that's good," not really quite realizing that you are hampering as opposed to helping.

    Dr. Smith: Well, a lot of the guys say do the cold plunge and then work out. That's what I've seen a lot of the people say, is wake up, get in the cold plunge, and then go throughout your day and do your workout and get the benefits of the cold plunge to start your day.

    Scot: Got it. I think we're good here. Mitch, do you think we're good? Have we explored this to the point you feel satisfied?

    Mitch: I think so. I think at the very least, I might try a cold shower tomorrow.

    Scot: Right.

    Mitch: That's the least I could try.

    Scot: Yeah, sure. I think I'm the same way. I don't know. We can get caught up in all these things that we think can help us and think is going to give us the edge when the reality is I know I need to be better at sleeping. I know I need to eat better foods. I know I should be exercising a little bit more than I do.

    But the price of entry if I'm not buying one of these thousand-dollar or multi-thousand-dollar machines, or even if you're buying a $500 tub, you've got to have a place to put it. You've got to maintain it. That could be a pain in the butt, right?

    If it's just a cold shower, and you just try to handle the cold water for two or three minutes, three or four times a week, and the downsides are minimal, sure, why not? But otherwise, I think I'm afraid that it could distract from doing the things that we really should do.

    And I think Dr. Smith kind of alluded to that, that it's hard to parse out in the research what it is that's actually giving us these benefits. But if it's a low entry cost and a low negative sort of chance that anything bad is going to happen, then why not, I suppose. I think that's my takeaway.

    John, what do you think?

    Dr. Smith: I agree. I mean, I've cold plunged multiple times and I think . . .

    Scot: What is it that you get out of it, by the way? I never asked that. Do you just get out and you go, "Yeah"? Is that what it's all about, or what?

    Dr. Smith: So one of the times I did it, we went from cold plunge to sauna because I was at a place where it had a cold plunge and a sauna.

    Scot: And I've done that. I love it. It's fun.

    Dr. Smith: It felt good. It was very refreshing, energizing in that. Now, the times where I've just done a cold plunge . . . Like, I've worked out with my brother and he's like, "Hey, we're going to cold plunge before we work out," or, "We're going to cold plunge after," or whatever and we've done that. Honestly, for me, I get out and it's more the sense of, "Okay, it's over. I'm still alive. Let's move on with the day."

    But in reality, I think I did feel better. I think I had more energy that day. And maybe that's the boost in the metabolic rate that you have after you cold plunge.

    I probably should just do it. Maybe we revisit this in a couple of months, and I just get down to where I do this every single day for a couple of months . . .

    Scot: That'd be cool.

    Dr. Smith: . . . and really just kind of take stock of how I feel, whether it's just on the days where I'm at home and I don't have a cold plunge and I just jump in the shower, versus being actually where I'm around a cold plunge.

    I mean, I'm willing to give it a go for the "Who Cares About Men's Health" crew and see what we think.

    Scot: All right. Very cool. Dr. Smith, thank you so much for doing all the research into this, taking a look at the literature out there to see if there are any quantifiable benefits that we could definitely say yes. It sounds like the answer is there are a lot of studies, but they're not necessarily great super strong studies. So the jury is still out on a lot of this.

    Dr. Smith: Yeah. I mean, it feels terrible to just say the same thing over and over again, but there are some of these things. I think it's worth looking into. It's worth thinking about. I mean, I think anything you're going to do to improve your health is worth looking into.

    Scot: If you have a story or something you want to share with cold plunges, if you've started doing them and noticed any sort of benefits yourself, we'd love to hear about that. You can always reach out to us at

    Thanks for listening. Thanks for caring about men's health.

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